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NURS 6053 Discussion Workplace Environment Assessment

NURS 6053 Discussion Workplace Environment Assessment

NURS 6053 Discussion Workplace Environment Assessment

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Incivility is not uncommon in nursing practice, but the factors that contribute to it cannot be identified without conducting a healthy work-setting inventory. As a result, I was excited when the Clarks Healthy Workplace Inventory became available because it would assess the healthiness or unhealthiness of my nursing environment. The results showed that my long-term acute care facility was in good health, with a score of 85 indicating high civility. Transparent and respectful communication, shared vision, employee satisfaction, and a focus on personal care were among the outcomes that stood out because they served as the foundation for civility in the workplace. Professor Gittell asserts in TEDx Talks (2017) that having the same vision, knowledge, and mutual respect leads to timely, accurate, and frequency, confirming how a civil setting should be designed.

When I think of this question about how to integrate appropriate information, I essentially think of having good advertising and marketing. You have to think of the populations you are trying to reach. I think it’s important to target two main populations younger people 30-45 that may need earlier screening because of high risk and then 45-75 that should be already getting regular screenings. Commercials are great. I am sure we have all heard of Cologuard because of their commercials. Cologuard is an additional way to screen for colorectal cancer but not a replacement for colonoscopies. Social media is also a great way to educate and advertise. But most importantly anytime you go to your primary care physician’s office the nurses, providers, and staff should be discussing regular screenings with the patients and have handouts around the offices with information that people can read while they wait. Also nurses or medical assistants pointing out to providers that a patient is a certain age and has not had a colonoscopy yet. Being the eyes and ears for patients is so important. Another thing for people to know is that insurance should cover these type of screenings at a 100%. This was one great thing about the Affordable Care Act. The Affordable Care Act requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF) (Centers for Disease Control and Prevention, 2022). The law stipulates that there should be no out-of-pocket costs for patients, such as co-pays or deductibles, for these screening tests (CDC, 2022). So for people with medical coverage, they should be taking advantage of these benefits.

During my nursing practice, I experienced incivility where my superior dictated the directions, and I had to nod in understanding. Suggestions from certain staff members including myself was discouraged and seemed to be totally rejected. I would have loved a more participative decision-making process because I have the skill set required to contribute to major discussions. After I had carried out the activities stipulated, I went to the physician and explicitly stated that I felt demeaned when he commanded me. To my surprise, he listened attentively and admitted he was under a lot of pressure. Marshall and Broome (2017) input that nurse leaders are required to have the skill set to steer the organization through the challenges, and this was one of them. According to Clark (2018), I exercised cognitive rehearsal techniques that involve identifying incivility and addressing it in a nonthreatening way. In conclusion, despite scoring a 4 in the assessment inventory, communication has improved significantly in the long term acute care facility because leaders recognize that the ideas of other nurses are essential.

You may think your current organization operates seamlessly, or you may feel it has many issues. You may experience or even observe things that give you pause. Yet, much as you wouldn’t try to determine the health of a patient through mere observation, you should not attempt to gauge the health of your work environment based on observation and opinion. Often, there are issues you perceive as problems that others do not; similarly, issues may run much deeper than leadership recognizes.
There are many factors and measures that may impact organizational health. Among these is civility. While an organization can institute policies designed to promote such things as civility, how can it be sure these are managed effectively? In this Discussion, you will examine the use of tools in measuring workplace civility.

NURS 6053 Discussion Workplace Environment AssessmentTo Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review and complete the Work Environment Assessment Template in the Resources.

By Day 3 of Week 7

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. Then, describe a situation where you have experienced incivility in the workplace. How was this addressed? Be specific and provide examples.

By Day 6 of Week 7

Respond to at least two of your colleagues on two different days by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.

Incivility refers to a milder form of uncivil behavior conducted with the aim of harming the target.  All forms of incivility entail dysfunctional interpersonal relationships attributed to high employee turnover and low quality of care (Kisner et al., 2018). Nurses have a responsibility to establish and promote healthy interpersonal relationships with one another. They need to know how their communication and behavior or failure to act can cause incivility (Abdollahzadeh et al., 2017). This essay will analyze the results from the Work Environment Assessment, review literature on incivility, and explore evidence-based strategies to create high-performance interprofessional teams.

Work Environment Assessment

Results of the Clark Healthy Workplace Inventory

My workplace scored 67/100 on the Clark Healthy Workplace Inventory. The result suggests that the workplace environment is Barely Healthy (Clark, 2015). This was an unexpected score, as I expected to have at least a score in the moderately healthy range.  I was surprised that we only scored 5 points in only four items. It is somewhat surprising that our organization could only score the maximum points in only four items, which means that we have a long way to promote a healthier workplace. The four items include: Promotion of Teamwork and collaboration, Treating employees fairly and respectfully, using effective conflict-resolution skills, and Providing competitive salaries, benefits, compensations, and other rewards.

I was also surprised that my workplace scored 1 point in two items in the Clark Inventory. This was surprising because our organization belongs to a caliber that should not have very low scores on matters associated with healthy workplaces.  The two items that had the lowest score were: The workload being reasonable, manageable, and fairly distributed and Organization attracting and retaining the best and the brightest.

Before completing the Clark Inventory, I assumed that unreasonable and unmanageable workload is a primary cause of failing to retain the organization’s best staff. I believed that unbearable nursing workloads and nurses shortages are interconnected, in that each leads to the other. This was confirmed by the assessment, where I established that the high unmanageable nursing workload in our workplace is the primary reason for failing to retain staff.

What the Results Suggest About the Health and Civility of My Workplace

The assessment results indicate a stressful work environment that can be attributed to an unreasonable, unmanageable, and unfairly distributed workload.  A Barely Healthy workplace suggests a problem with the organization’s leadership; in that, the leaders are more goal-oriented than people-oriented. This results in the management focusing more on meeting its clients’ needs at the expense of the staff needs (Abdollahzadeh et al., 2017).  The results also mean that the staff’s needs may be overlooked, and their voice is not often considered during policy-making. Furthermore, they suggest that the staff may not be adequately engaged in making decisions that affect them, and the leadership does not recognize shared governance.

Despite the average results, the organization scored highly in items that indicate high civility in the workplace. These items include: Promotion of Teamwork and collaboration, Treatment of employees fairly and respectfully, and Use of effective conflict-resolution skills (Clark, 2015). The high scores in these items suggest that a culture of civility has been developed in the workplace.  It also means that the employees have strived to create and maintain civil, healthy work environments by communicating clearly and effectively, despite the harsh working environment. Besides, it shows that the staff manages conflict in the workplace respectfully and responsibly.

Reviewing the Literature

The article by Clark (2015) presents the concept of healthy work environments. The article mentions the six standards by AACN that are vital in establishing and sustaining healthy work environments, namely, skilled communication, effective decision-making, true collaboration, appropriate staffing, meaningful recognition, and authentic leadership (Clark, 2015). Clark also presents other standards from her research, crucial in promoting healthy work environments, which include: A common organizational vision, values, and team norms; Emphasis on both formal and informal leadership; Creation and sustenance of a high level of the individual, team, and organizational civility; and Civility conversations at all organizational levels.

Clark argues that when an uncivil encounter occurs, we may require to address it by having a critical conversation with the uncivil person. One needs to be well-prepared for this critical conversation, speak with confidence, and use respectful expressions (Clark, 2015). Critical conversations are often stressful. Thus, while taking a direct approach to resolving a conflict, it requires courage, know-how, and lots of practice. By having this conversation, one can end the silence that surrounds incivility. The article presents the DESC model, which can be used to address incivility in the workplace. The DESC model has four elements: D-Describe the specific situation, E-Express your concerns, S-State other alternatives; and C-Consequences stated (Clark, 2015). The critical conversations can occur more effectively when one is well-equipped with tools like this DESC model.

How the Concept Presented In the Article Relates To the Results of the Work Environment Assessment

The concept on the standards of sustaining a healthy work environment relates to the assessment results, in that ineffective decision-making, lack of appropriate staffing, and lack of authentic leadership in the organization has resulted in a less healthy environment. Lack of authentic leadership is evident in the workplace environment, which suggests that the organization’s leaders have not put much effort into ensuring the staff work in a healthy work environment. The leaders at my organization do not initiate or encourage open discussions and dialogues on promoting a healthy workplace. If they do so, they could have identified key factors that create a harsh working environment, such as inadequate staffing.

Ineffective decision-making by failing to engage the employees has contributed to a less healthy workplace. This is because the staff’s opinions on enhancing the workplace environment are not incorporated in policy-making. The low assessment results can be related to the employees’ failure to initiate a critical conversation with the management on issues that affect them. Perhaps, if we expressed their concerns to the leaders, we could be heard, and the various issues that negatively impact the workplace could be addressed. The tense relationship between the employees and the management can be attributed to the lack of conversations between the two groups, which is critical in ending the silence surrounding incivility.

How My Organization Could Apply the Concept to Improve Organizational Health

My organization can apply the identified standards to enhance organizational health by having direct and transparent communication at all organizational levels to promote respect among the staff and between the staff and the supervisors. The management can actively engage the staff by consulting or involving them in decision-making and developing organizational policies (Griffin & Clark, 2014). Additionally, the organization’s employees can apply the concept of critical conversation to discuss with the management on issues affecting them, such as inadequate staffing (Clark, 2015). Critical conversations can be started among the employees to help solve conflicts, especially between different professions, to help create strong intra- and interprofessional health teams.

Evidence-Based Strategies to Create High-Performance Interprofessional Teams

Strategies That Can Be Implemented To Address Any Shortcomings

The article by Clark (2019) discusses the use of Cognitive Rehearsal to address incivility that threatens patient safety.  Cognitive rehearsal (CR) is a technique employed in behavioral science whereby people work with a skilled facilitator to identify and rehearse effective methods of addressing a problem or social situation (Clark, 2019). It is intended to lessen anxiety, enhance confidence, and increase impulse control by practicing effective methods to solve potentially stressful situations. CR has been established to be an effective strategy to solve incivility in clinical practice and educational settings (Clark, 2019). A planned, rehearsed response presents a chance to convey expectations for appropriate behaviors and future interactions.

The article by Kisner et al. (2018) discusses the Mixed-intervention strategy, which effectively addresses incivility. The strategy entails the following steps: Providing personal support, education, and mediation between the perpetrator and the target. Using corrective action to discipline the perpetrator and educating the target to handle aggression (Kisner et al., 2018). The strategy also involves imposing policies and penalties to deal with aggressive behaviors. The last step is encouraging social interaction and interventions that promote collective responsibility in creating a safe and supportive culture.

Strategies That Can Be Implemented To Bolster Successful Practices

Successful practices in the workplace environment can be enhanced by holding Team-building sessions in organizations. The team-building sessions should build trust, engage staff in decision-making, clarify roles, and role-model positive interactions. Simulation can be employed in these sessions to promote better teamwork and collaboration. For instance, the simulation activity can involve a nurse role-modeling positive interactions with other nurses. The role-modeling can be useful in demonstrating to the staff the power of positivity in employees’ communication.

Organizations can develop and impose a zero-tolerance policy for incivility, which clearly outlines uncivil behaviors. The policy should be clear that incivility will not be tolerated in the organization, and if it happens, consequences will result. For instance, the policy can indicate that a staff who displays uncivil conduct will be given a verbal and written warning for each violation, and after three violations, they will be terminated. A policy is a very effective strategy as it outs employees conducting incivility on notice. Once the policy is developed, the management can conduct staff development programs for staff and managers about the zero- incivility tolerance policy. The programs can include enhancing communication skills, challenging culprits, and using silence to facilitate thinking.

 References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to Prevent Workplace Incivility?: Nurses’ Perspective. Iranian journal of nursing and midwifery research22(2), 157–163. https://doi.org/10.4103/1735-9066.205966

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Research in Nursing Education| Nurse Educator44(2), 64-68. http://doi.org/10.1097/NNE.0000000000000563

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today10(11), 18-23.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing45(12), 535-542. http://doi.org/10.3928/00220124-20141122-02

Kisner, T. (2018). Workplace incivility: How do you address it?. Nursing201948(6), 36-40. http://doi.org/10.1097/01.NURSE.0000532746.88129.e9

Leadership Week 7 Initial Postfound that the team worked well together and communicated effectively presenting a work environment that was civil and healthy
and I am proud to be apart of .
The main idea that I had regarding the results was that the organization runs smoothly because of the shared mission, values
and goals of the organization. Christus Good Shepherd’s mission is to extend the healing ministry of Jesus Christ with core values of
dignity, integrity, excellence, compassion, and stewardship. The vision of Christus Health is to be a leader and advocate in the
creation of innovative health and wellness solutions to improve the lives of the individuals of the community so that all may
experience the healing love of Jesus Christ (Christus Health, 2021). However, as shown by the results of the assessment not falling
in the top category, the current pandemic has put a strain on certain aspects including competitive pay and tension in everyday
work.
One instance where I have felt that I had an uncivil encounter was when I was in the ICU and one of the physicians started yelling
orders at me during a stressful situation and griping in front of the patient that it was late in the day to be inserting lines and such.
Clark (2015) states that the most effective way to stop incivility is to address it when it occurs. However, this takes practice and
requires effective communication and competent dialogue. At the time, I was unable to address the physician outside of the
patient’s room, however I have a wonderful team that did address it with the doctor. The team member gently spoke with the
physician in the appropriate environment and reminded him that we are all exhausted, but that appropriate communication is
essential to decrease work stress between staff and provide safe and effective patient care. Working under conditions of civil
communication, promotes role performance of team members (Liu, et. al., 2020). Even under stressful working conditions, it is
important for each team member to promote a civil working environment to support optimum work performance of each team
member.

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References

Christus Health (2021). Christus Health: Our vision, mission, and values. Retrieved from https://www.christushealth.org/about/our-
mission-values-and-vision

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23. Retrieved
from https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.

Liu, Y., Vashdi, D. R., Cross, T., Bamberger, P., & Erez, A. (2020). Exploring the puzzle of civility: Whether and when team civil
communication influences team members’ role performance. Human Relations, 73(2), 215–241. https://doi-
org.ezp.waldenulibrary.org/10.1177/0018726719830164

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RE: Discussion – Week 7

I enjoyed reading your response. Our organizations share a few similarities. We have experienced a mass exodus of well-trained nurses leaving to working as COVID travel nurses. One of my co-workers got frustrated with floating to the COVID unit weekly and decided that she was better off working as a travel nurse. She loves the pay and the flexibility. I am happy that our organization has offered bonuses and critical pay to entice nurses to stay so we have not been hit hard with the nursing shortage like other places. Having financial incentive makes the stress somewhat bearable. My organization has been focusing on the wellness of its employees during this time. We had licensed massage therapists come and give shoulder massages during the Christmas break. That was a welcomed and much needed treat.
Effective communication is the key to achieving organizational goals (Luu & Phan, 2020, p. 31). I am glad your new unit utilizes effective communication. Effective communication has been shown to enhance the quality of patient care and reduce errors (Broome & Marshall, 2020, p. 157). According to Broome and Marshall (2020), active listening is the most effective tool for successful communication. Yelling is verbal abuse. According to Clark (2015), bullying and harassment should not be tolerated. Kudos for your team member speaking up against the yelling doctor because such behavior can negatively impact one’s ability to perform their job. “Engaging in clear and courteous communication fosters a civil work environment” and enhances the delivery of care (Clark, 2015, p. 19). Clark (2019) developed an evidence-based technique where nurses can practice addressing workplace issues in a safe environment with a trainer overseer. I think your organization would benefit from having such a class in place, especially for new staff members to teach them how to address stressful situations effectively.

References

Broome, M., & Marshall, E. S. (2020). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed.). Springer Publishing Company.
Clark, C. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 20. https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf
Clark, C. M. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563
Luu, D. T., & Phan, H. V. (2020). The Effects of Transformational Leadership and Job Satisfaction on Commitment to Organisational Change: A Three-Component Model Extension Approach. The South East Asian Journal of Management, 14(1), 31–33. https://doi.org/10.21002/seam.v14i1.11585

RE: Discussion – Week 7

I really enjoyed reading your post. As you stated incivility is just as insidious and disruptive to productivity as more extreme behaviors. In fact, it’s been described as the “gateway drug” to workplace harassment or creation of a hostile work environment which makes incivility worthy of every leader’s attention (Monych, 2018). Incivility means different things to different people, so it can be easy for a manager to overlook or miss. This conduct tends to be less of a black-or-white issue compared to more blatant forms of undesirable work conduct such as sexual harassment, stealing, or lying (Monych, 2018).

Working in an environment where your manager express concerns and can be trusted means a lot and makes you feel valued as an employer. Regardless of a person title, respect goes a long way. Working in a healthy environment is beneficial for the staff as well as the patients too. Most people value civility. They want to treat one another how they themselves want to be treated. But sometimes, things get in the way. External pressure, the pressure to produce results no matter what, can act like a bug in the operating system (Edmonds, 2017). Otherwise, civil people can “malfunction,” behaving in ways they never would otherwise; treating one another in ways that are dismissing, discounting, and demeaning (Edmonds, 2017).

Reference

Edmonds, S. C. (2017, April 14). Council Post: Four Steps Proven To Cultivate Workplace Civility. Retrieved April 12, 2021, from Forbes website: https://www.forbes.com/sites/forbescoachescouncil/2017/04/14/four-steps-proven-to-cultivate-workplace-civility/?sh=36c3f98137cf

Monych, B. (2018, July 3). 6 ways to combat workplace incivility – Insperity. Retrieved from Insperity website: https://www.insperity.com/blog/workplace-incivility/

I agreed with your post Sunday, Incivility among healthcare workers can thus lead to unsafe working conditions and the safety of a patient. Care providers and organizational leaders must communicate in a way that fosters civility and empowers nurses to speak up. They must strive to create and sustain a healthy work environment where courtesy is evident. Overall, Companies should come up with a no tolerance policy for incivility in the workplace. The procedure could have a penalty resulting in every infringement, verbal caution for the initial offense, written caution for the second mistake, non-payment leave for the third one, and termination. The department of human resources should be included in the policymaking process. If incivility at the workplace is tolerated, destructive behaviors become commonplace and continue in the working environment. Each team member in a company should be educated on the right professional characters with the job code of conduct. Both staff and nurse managers must have the ability to identify it, taking it seriously, and cease the action in its ways.

References

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

Cimarolli, V. R., Bryant, N. S., Falzarano, F., & Stone, R. (2022). Factors associated with nursing home direct care professionals’ turnover intent during the covid-19 pandemic. Geriatric Nursing48, 32–36. https://doi.org/10.1016/j.gerinurse.2022.08.012Links to an external site.

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563Links to an external site.

Great post Ephraim,

I agreed with you that health institutions should acknowledge incivility as a problem as well.  Addressing incivility at health institutions is crucial for patient safety, staff well-being, interprofessional collaboration, organizational culture, and maintaining a positive reputation (Rosenstein & O’Daniel, 2021). Research has shown that incivility in healthcare settings has negative consequences for both healthcare professionals and patients. Rosenstein and O’Daniel (2021), explored the impact of disruptive behavior, including incivility, on clinical outcomes from the perspectives of nurses and physicians. They found that such behaviors negatively affect patient care and outcomes. This highlights the urgent need for health institutions to acknowledge and actively address incivility to enhance patient safety and quality of care. Furthermore, Edrees and Hamdan (2020), demonstrated that incivility and negative work environments contribute to professional burnout among healthcare professionals. The study emphasizes the importance of health institutions recognizing and addressing incivility as a significant factor in burnout.

The Joint Commission (2018), a prominent healthcare accreditation organization, has also addressed this issue in its Sentinel Event Alert. They identify behaviors that undermine a culture of safety, including incivility, and stress the importance of creating a culture of respect and safety within health institutions. The Joint Commission’s stance further supports the notion that health institutions must recognize and tackle incivility as a problem that can jeopardize patient well-being.

In conclusion, by addressing incivility, health institutions can promote patient safety, improve psychological well-being among healthcare professionals, enhance interprofessional collaboration, and ultimately provide high-quality care.

References

Edrees, H. H., & Hamdan, M. (2020). The relationship between civility, psychological safety, and burnout in nursing. Journal of Nursing Management, 28(7), 1627-1635. https://doi:10.1111/jonm.13052

Links to an external site..

Rosenstein, A. H., & O’Daniel, M. (2021). Impact of disruptive behavior and communication defects on patient safety. Joint Commission Journal on Quality and Patient Safety, 47(6), 373-380. https://doi:10.1016/j.jcjq.2020.08.001

Links to an external site..

The Joint Commission. (2018). Behaviors that undermine a culture of safety. Sentinel Event Alert, (59). Retrieved from https://www.jointcommission.org/sea_issue_59/